<!DOCTYPE html> 
<html> 
	<head> 
	<title>Leave Session</title> 
	
	<meta name="viewport" content="width=device-width, initial-scale=1"> 

	<link rel="stylesheet" href="http://code.jquery.com/mobile/1.0b2/jquery.mobile-1.0b2.min.css" />
	<script type="text/javascript" src="http://code.jquery.com/jquery-1.6.2.min.js"></script>
	<script type="text/javascript" src="http://code.jquery.com/mobile/1.0b2/jquery.mobile-1.0b2.min.js"></script>
</head> 
<body> 

<div data-role="page">

	<div data-role="header">
		<h1>Leave Session</h1>
	</div><!-- /header -->

	<div data-role="content">	
		
		<div data-role="fieldcontain">
    		<label for="name">Current Location:</label>
    		<input type="text" name="name" id="name" value=""  />
		</div>	
		
		<div data-role="fieldcontain">
    		<label for="name">Destination:</label>
    		<input type="text" name="name" id="name" value=""  />
		</div>	
		
		<div data-role="fieldcontain">
    		<fieldset data-role="controlgroup" data-type="horizontal" >
    			<legend>Travel Mode:</legend>
         			<input type="radio" name="radio-choice-1" id="radio-choice-1" value="choice-1" checked="checked" />
         		<label for="radio-choice-1">Cab</label>

         		<input type="radio" name="radio-choice-1" id="radio-choice-2" value="choice-2"  checked="unchecked"/>
         		<label for="radio-choice-2">Bus</label>
         		
         		<input type="radio" name="radio-choice-1" id="radio-choice-3" value="choice-3"  checked="unchecked"/>
         		<label for="radio-choice-2">Ferry</label>


				<input type="radio" name="radio-choice-1" id="radio-choice-4" value="choice-4"  checked="unchecked"/>
         		<label for="radio-choice-2">Car</label>
         		
         		<input type="radio" name="radio-choice-1" id="radio-choice-5" value="choice-5"  checked="unchecked"/>
         		<label for="radio-choice-2">Foot</label>

       		</fieldset>
		</div>
		
		<div data-role="fieldcontain">
    		<label for="name">Emergency Contact</label>
    		<input type="text" name="name" id="name" value=""  />
    		<a href="index.html" data-role="button" data-inline="true">Call</a>
		</div>	
		
	
		<a href="index.html" data-role="button">Submit button</a>
		
					
	</div><!-- /content -->

	<div data-role="footer">
		<h4>Page Footer</h4>
	</div><!-- /footer -->
</div><!-- /page -->

</body>
</html>
